Do you have friends or loved ones with lots of clutter? Do you wonder whether they might suffer from a compulsive hoarding problem? Compulsive hoarding is a distinct mental disorder according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5. People who have compulsive hoarding disorder show many common traits. You can watch for these signs and behaviors and try to judge by the DSM-5’s criteria to come to an informal diagnosis.

Steps

Part 1

Watching for Characteristic Signs

1

Look for cluttered living spaces. The main characteristic of compulsive hoarding disorder is difficulty getting rid of or parting with possessions, leading to a cluttered and sometimes uninhabitable house. These items may include almost anything, such as clothing, newspapers, junk mail, toys, books, garbage, or extra napkins from a restaurant.[1]

People who have compulsive hoarding disorder can have items cluttered everywhere, from the counter-tops to tables and sinks, stoves, stairways, and beds. This can result in some rooms or areas of the room being unusable, such as not being able to cook in the kitchen.

People who have compulsive hoarding disorder may also start to hoard items in garages, cars, and yards once space in the house runs out.

2

Watch for unsanitary conditions. With so much clutter, it can be hard for people who have compulsive hoarding disorder to clean. More than that, their drive to collect items and distress about throwing things out can create unsanitary conditions in the home. This is another giveaway that something is wrong.[2]

People who have compulsive hoarding disorder may let old food and trash build up. It may start to rot and cause foul odors in the home. Food in the refrigerator may also be spoiled or expired, because the owner does not want to get rid of it.

Some people who have compulsive hoarding disorder may also actively collect trash or other unsanitary objects. They may let newspapers, magazines, and junk mail pile up, as well.

3

Note a lack of organization. Lack of organization is common in people who have compulsive hoarding disorder. Collections can be large but are not normally cluttered and DO NOT impair one’s living conditions.[3] While collectors look for single kinds of items like coins and stamps and then arrange and carefully organize these items, people who hoard do not organize items in this way. People who have compulsive hoarding disorder may acquire all sorts of things – many seemingly useless – and have trouble organizing them. This is called “underinclusion,” a pattern of thinking that interferes with grouping similar items together.[4]

For example, a person who has compulsive hoarding disorder may have a hard time making a single group for yarn or even grouping it by color. Instead, he will create separate groups for each and every item: for robin egg blue yarn, sky blue yarn, cyan blue yarn, dark blue yarn, and so forth, with each item seen as unique.

4

Keep an eye out for animals. About 40% of people who have compulsive hoarding disorder are also animal hoarders. This means that the person has a compulsive need to “collect” and care for animals, usually cats or dogs, but ends up with so many that he becomes overwhelmed. While the person usually has good intentions, the result is often unintentional animal neglect or abuse.

People who have compulsive hoarding disorder can have dozens of animals living in a single house. They are often preoccupied with looking for new animals, checking shelters and adoption websites, or searching alleys for strays.

Apart from numbers, the health of the animals may also be a giveaway. People who hoard animals often have trouble caring properly for their pets. The animals might be malnourished and under extreme stress. Sometimes, animals die and are not found because of the clutter.

Part 2

Noting Psychological Behavior

1

Watch for over-attachment to objects. Hoarding isn’t just passively allowing items to build up over time, but instead comes from a conscious effort to save things. People who have compulsive hoarding disorder can have many reasons for collecting and keeping objects. They might not want to be wasteful, they may have sentimental attachment to the items, or they may think that items in their hoard will come in handy someday. All of this contributes to an extreme over-attachment.[5][6]

People who have compulsive hoarding disorder may be uncomfortable about letting other people touch or borrow their possessions. They may also show distress at the idea of getting rid of items. This distress is related to their perceived need to save things.

About 80% to 90% of people who have compulsive hoarding disorder are also “acquisitive,” which means that they not only keep items but also excessively acquire things for which there is no need or room.

2

Observe distress at having to part with possessions. Psychologically, caches of items are sort of like a “protective shell” for the person with compulsive hoarding disorder. They may not recognize that hoarding is a problematic behavior, even in spite of proof to the contrary, and can be in a state of denial. The mere thought of getting rid of items can therefore cause them great distress.[7]

Some people who have compulsive hoarding disorder will go into a panic when an object is only moved – not even discarded. They may interpret pressure to clean as a personal violation and will quickly rebuild, sometimes within months.

A non-sufferer sees clutter that can be cleared away – rooms that can be used, beds that can be slept in, meals that can be cooked. However, a person with compulsive hoarding disorder treats the home like a storage facility rather than a living space.

3

Note correlations with other disorders. Compulsive hoarding doesn’t always occur on its own. It oftentimes develops alongside other mental or behavioral issues. Watch out for these patterns in loved ones that you think might suffer from compulsive hoarding disorder.[8]

Hoarding can also be accompanied by an eating disorder, Prader-Willi syndrome, psychosis, dementia, or pica, which is a condition that causes people to want to eat materials that are not usually eaten, such as dirt or hair.[10]

Part 3

Getting Tested and Diagnosed

1

Ask for a psychological evaluation. To diagnose compulsive hoarding, mental health professionals will have to do a full evaluation of the person in question. They will ask the person questions about her acquiring and getting rid of objects and about her overall mental well-being. Expect these questions to relate to the behaviors associated with compulsive hoarding disorder.[11]

Mental health providers may also ask the person about her psychological state to see if she displays symptoms of other disorders, like depression.

With permission, they can also question family members and friends to get a rounded picture of what is going on.

2

Assess according to the DSM-5 criteria. The DSM-5 lists compulsive hoarding as a distinct mental disorder with six specific criteria. You can try to determine if someone might have compulsive hoarding disorder using these criteria. If she meets the criteria in total or in large part, then she is probably diagnosable.[12][13] The first four criteria are related to the hoarding behavior and they include:

People who have compulsive hoarding disorder show a persistent difficulty in getting rid of objects, regardless of actual value.

Their difficulty is due to a perceived need to save items and to distress that they feel when discarding them.

The result of this difficulty is the accumulation of large amounts of objects that congest and clutter living areas of the person’s home.

Hoarding causes significant distress and impairment in social, occupational, and other areas of life, including keeping a safe living space.

3

Make sure the behavior is not caused by another issue. To be considered compulsive hoarding, the last DSM-5’s last two criteria state that a person’s behavior can’t be due to other medical conditions or be better explained as symptoms of another mental disorder. This includes things like brain injuries, Prader-Willi syndrome, or OCD.[14][15]

Hoarding can appear in people with neurodegenerative disorders, that is, problems with the brain’s functioning like dementia or brain damage. Doctors will have to make sure that this is not what’s behind the behavior.

Prader-Willi syndrome is a genetic disorder that results in mild cognitive disability. It can also include obsessive behavior, like the hoarding of food and other objects.

Doctors should also make sure that the accumulation of objects is not due to a lack of energy from depression. Hoarding is active, not passive.